However, using the "shotgun" approach by treating everyone with prophylactic anticoagulation
may not be cost-effective, and could potentially lead to complications from therapy.
Prophylactic anticoagulation was defined as unmonitored vitamin K antagonist use (1 mg daily of warfarin) for the duration of PICC use.
Specifically, to our knowledge, our study is the first to show that patients receiving current treatment for cancer are at increased risk for PICC-associated DVT and that this risk is not reduced by the use of commonly used prophylactic anticoagulation.
Although several studies in patients with malignancy and nonperipherally inserted central venous catheters suggest that prophylactic anticoagulation with low-dose warfarin may reduce the incidence of DVT, (14,15) a more recent prospective trial of low-dose (1 mg) unmonitored warfarin therapy performed by Heaton and colleagues showed no reduction in the risk of thrombosis in cancer patients with central venous catheters.
Although pre-operative initiation of prophylactic anticoagulation
is desirable, there are data indicating that starting prophylaxis postoperatively is adequate.
In addition, for patients receiving ESAs pre-operatively for reduction of allogeneic blood transfusions, a higher incidence of deep venous thrombosis was documented in patients receiving Epoetin alfa who were not receiving prophylactic anticoagulation
Preliminary data suggests that patients who are appropriate candidates may benefit from concurrent prophylactic anticoagulation
or aspirin treatment.
Perisurgery: PROCRIT increased the rate of deep venous thromboses in patients not receiving prophylactic anticoagulation
Patients receiving PROCRIT pre-operatively for reduction of allogeneic RBC transfusions: A higher incidence of deep venous thrombosis was documented in patients receiving PROCRIT who were not receiving prophylactic anticoagulation
Patients receiving ESAs pre-operatively for reduction of allogeneic blood transfusions: A higher incidence of deep venous thrombosis was documented in patients receiving PROCRIT who were not receiving prophylactic anticoagulation